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Hyperthyroidism and Symptoms
Hi Dr. Mark,
I was diagnosed with hyperthyroidism a little over 1 month ago. My bloodwork showed that my TSH = .178, T3 Uptake = 25, and T4 Free Direct = 1.24. I'm currently taking 20 mg of Methimazole and 75 mg of Toprol XL (just for the past week. For the 2 prior weeks, I was taking 10 mg of Methimazole and 25 mg of Toprol XL). My endocrinologist is telling me that my labs "aren't that bad", so she doesn't quite understand why I continue to have some of the symptoms that I'm experiencing (I feel quite anxious all of the time and have a hard time in certain settings (meetings, going to lunch with friends, etc.) I also feel shaky all of the time, dizzy, have significant neck pain which is causing tension headaches, pressure in my ears, etc. Is this normal? Should the Methimazole and Toprol help with these symptoms (given more time), or do I need to address these separately (such as taking anxiety medication, or muscle relaxants for the neck pain)? I obviously would prefer not to be loaded up on medication, but I haven't really seen any relief with the current medication I'm on.
I was diagnosed with hyperthyroidism a little over 1 month ago. My bloodwork showed that my TSH = .178, T3 Uptake = 25, and T4 Free Direct = 1.24. I'm currently taking 20 mg of Methimazole and 75 mg of Toprol XL (just for the past week. For the 2 prior weeks, I was taking 10 mg of Methimazole and 25 mg of Toprol XL). My endocrinologist is telling me that my labs "aren't that bad", so she doesn't quite understand why I continue to have some of the symptoms that I'm experiencing (I feel quite anxious all of the time and have a hard time in certain settings (meetings, going to lunch with friends, etc.) I also feel shaky all of the time, dizzy, have significant neck pain which is causing tension headaches, pressure in my ears, etc. Is this normal? Should the Methimazole and Toprol help with these symptoms (given more time), or do I need to address these separately (such as taking anxiety medication, or muscle relaxants for the neck pain)? I obviously would prefer not to be loaded up on medication, but I haven't really seen any relief with the current medication I'm on.
MEDICAL PROFESSIONAL
Your thyroid function seems to be improving - I am not sure if you have Graves - let's see what the other antibody tests show.
You may have subacute thyroiditis which is a transient over-activity of the thyroid due to inflammation. Tapazole doesn't help and usually patients go through a hypo phase 5-7 weeks after symptoms begin. The way to document this is the I-123 uptake scan -- which is still the best isotope study for hyperthyroidism (side-note to ancientmariner) -- would need to stop tapazole x5days to do scan.
You may have subacute thyroiditis which is a transient over-activity of the thyroid due to inflammation. Tapazole doesn't help and usually patients go through a hypo phase 5-7 weeks after symptoms begin. The way to document this is the I-123 uptake scan -- which is still the best isotope study for hyperthyroidism (side-note to ancientmariner) -- would need to stop tapazole x5days to do scan.
MEDICAL PROFESSIONAL
Remission is usually defined as one year of "normal" labs without needing anti-thyroid meds. If you still need tapazole, you aren't quite in remission - the absence of antibodies (? TSH-receptor Ab's?) is a good sign. Usually I treat with tapazole (or less commonly PTU) for 12-18 months, minimizing the dose to keep the thyroid labs normal. If I cannot get a patient off anti-thyriod meds after 18 months I would usually recommend RAI.
Hi Dr Mark, hope you can see this question. When would you say a person is in remission from Graves? I've been recently retested for ABs and they came back negative. However, I still need a very low dosis of Tapazole (5 mg/daily) to keep my values within range. I have an appt to see my endo in 3 weeks, but wanted to know your opinion if possible. Thanks!
I read somewhere, and can't find it now, that the I-123 uptake is an outdated test and there is another, better method to determine Graves' for sure. Do you know anything about this? I'll keep trying to find the article. I've also read theories that Graves' IS the hyper side of Hashi's - an interesting theory, but haven't seen any studies.
Thanks again for the info.
I think I might try a new endo (or at least get a second opinion). In the meantime, I'm doing some "independent" bloodwork, and requested (1) Antithyroid Antibodies (Thyroglobulin Antibodies and Thyroid Peroxidase Antibodies), (2) Thyroid Panel (Free T3, Free t4 and TSH), and (3) TRAb and TSI Combination Panel. Hopefully this will help me figure out what exactly is going on. Once again, thanks for the insight.
I think I might try a new endo (or at least get a second opinion). In the meantime, I'm doing some "independent" bloodwork, and requested (1) Antithyroid Antibodies (Thyroglobulin Antibodies and Thyroid Peroxidase Antibodies), (2) Thyroid Panel (Free T3, Free t4 and TSH), and (3) TRAb and TSI Combination Panel. Hopefully this will help me figure out what exactly is going on. Once again, thanks for the insight.
ATD means anti-thyroid drug therapy...medication that cuts down on the amount of thyroid hormone produced by the thyroid gland.
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